Transanal endoscopic microsurgery (TEM) for early rectal cancer

To determine the efficacy and safety of TEM compared to radical surgical resection (RSR) in patients with early rectal cancer. Methods A meta-analysis was performed following a search of the Pub Med, EMBASE and Cochrane Central Register of Controlled Trials databases. Only randomised controlled trials comparing TEM and RSR were considered for inclusion. Results Four trials with a total of 363 patients with early rectal cancer were included. There was no difference in over-all survival (OR 0.93; 95% CI), in rectal cancer-specific survival (OR 1.08; 95% CI), or for distant metastasis (OR 0.86; 95% CI) between the two groups. There was shorter length of hospital stay (OR -3.28; 95% CI), shorter operating time (OR -81.82; 95% CI), less blood loss (OR -138.70; 95% CI) and fewer post-operative complications (OR 0.30; 95% CI) in the TEM group. However local recurrence rate was higher in the TEM group compared to RSR. Conclusion This study has shown that in patients with early rectal cancer, TEM does offer oncologic control comparable to RSR and is associated with shorter hospital stay, less operating time, less blood loss and less post-operative complications. However, there appears to be a higher rate of local recurrence that warrants further study.